Shift to home care will aid Hoosier elders

July 23, 2006

Some of the most important decisions made in Indiana this year will concern the quality, availability and variety of care for elder residents. One decision that already has been made is a credit to the Family and Social Services Administration. It has become the basis for much needed change. We liked the response last month of Indiana Division of Aging Director Stephen A. Smith when, during a visit to South Bend, he considered that there are 10 times as many Hoosiers living in nursing homes as there are receiving alternative types of care. "That's terrible," Smith said. Indeed it is. But it is also changing. Until this year, almost all of the public money in Indiana used for long-term care for the elderly had gone to nursing homes, with just a pittance to home- and community-based care. Now, many more Hoosier elders will qualify for help with assisted living, home health care and adult day care. As of July 1, the maximum income one could have and still qualify for Medicaid help with those services changed from about $600 a month to about $1,500 a month. With this welcome shift, Indiana's bias toward nursing home care also will shift. It isn't that nursing homes aren't needed. They most assuredly are, as a series last week by Tribune staff writer Joseph Dits clearly showed. The state of Indiana must hold nursing homes to a high standard and make sure there are adequate around-the-clock care facilities available. As the baby boomers age, the demand for nursing homes undoubtedly will increase. The number of people who need help to stay in their own homes or at some level of semi-independent living will increase, too. But before Indiana starts keeping up with new demand, it has a lot of catching up to do. Indiana ranks 48th among states for percentage of non-nursing home Medicaid spending for long-term care of the elderly. While Indiana spends 84 percent of Medicaid elder care dollars on nursing homes, the figure nationally is 70 percent. The fact that it has been easier in Indiana to receive Medicaid-funded nursing home care than Medicaid-funded home care has been a real disservice to taxpayers, too. Last year, nursing home care cost an average of $38,298 a year per person. Home- or community-based care cost $25,954. Add to that the certainty that most elders would like to stay in their own homes, or at least not go to a nursing home, and the FSSA's determination to depart from the status quo in Indiana is even more commendable. Still another reason to expand the choices for elders occurs to us. A shortage of care for elders not living in nursing homes seems to be a very likely reason for the high level of unmet needs among senior Hoosiers. A survey commissioned by the Community Foundation of St. Joseph County and released in May turned up some disturbing results. Consider the data:

60 percent of St. Joseph County residents feel safe in their neighborhoods, compared to 70 percent nationally.

70 percent of county residents have at least one unmet daily living need, compared to 48 percent nationally. It seems logical that increased funding for home assistance services will increase those services' availability. Elders' awareness and use of services then will increase, too. The result will be elders who are more healthy, confident and independent. At the start of this year, there were about 35,000 people in Indiana on waiting lists for home care. The waiting period has hovered around three years. The two most common ways to get off the home care waiting list were going to a nursing home or dying. That disturbing reality reflected the success of an effective nursing home lobby at the Indiana General Assembly. But no one else benefited. We are very glad to see the beginning of a major policy shift. Indiana will be a better place to live and grow old because of it.